Healthcare Provider Details

I. General information

NPI: 1124954185
Provider Name (Legal Business Name): MRS. DIANE AYALA-COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25741 W ST KATERI DR
BUCKEYE AZ
85326-2134
US

IV. Provider business mailing address

25741 W ST KATERI DR
BUCKEYE AZ
85326-2134
US

V. Phone/Fax

Practice location:
  • Phone: 602-855-0273
  • Fax: 602-786-6794
Mailing address:
  • Phone: 602-855-0273
  • Fax: 602-786-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-27145
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: